| NPI | 1548242845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other Orthopedic Assistant (Licence: 604) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2025-10-26 |